| NPI | 1194105049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.17408) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.350094-1) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17408-NP) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2022-08-29 |